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1.
Ann Bot ; 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32157299

RESUMO

BACKGROUND AND AIMS: Floral chemical defence strategies remain understudied despite the significance of flowers to plant fitness, and the fact that many flowers contain secondary metabolites that confer resistance to herbivores. Optimal defence and apparency theories predict that the most apparent plant parts and/or those most important to fitness should be most defended. To test whether within-flower distributions of chemical defence are consistent with these theories we used cyanogenic glycosides (CNglycs), which are constitutive defence metabolites that deter herbivores by releasing hydrogen cyanide upon hydrolysis. METHODS: We used cyanogenic florets of the genus Lomatia to investigate at what scale there may be strategic allocation of CNglycs in flowers, what their localisation reveals about function, and whether levels of floral CNglycs differ between eight congeneric species across a climatic gradient. Within-flower distributions of CNglycs during development were quantified, CNglycs were identified and their localisation visualised in cryo-sectioned florets using mass spectrometry imaging (MALDI-MSI). KEY RESULTS: Florets of all congeneric species studied were cyanogenic, and concentrations differed between species. Within florets there was substantial variation in CNglyc concentrations, with extremely high concentrations (up to 14.6 mg CN g-1 DW) in pollen and loose, specialised surface cells on the pollen presenter, among the highest concentrations reported. Two tyrosine-derived CNglycs, the monoglycoside dhurrin and diglycoside proteacin, were identified. MALDI-MSI revealed their varying ratios in different floral tissues; proteacin was primarily localised to anthers and ovules, and dhurrin to specialised cells on the pollen presenter. The mix of transient specialised cells and pollen of L. fraxinifolia was ~11% dhurrin and ~1.1% proteacin by mass. CONCLUSIONS: Tissue-specific distributions of two CNglycs and substantial variation in their concentrations within florets suggests their allocation is under strong selection. Specific, high CNglyc concentrations in transient cells challenge the predictions of defence theories, and highlight the importance of fine-scale metabolite visualisation, and the need for further investigation into the ecological and metabolic roles of CNglycs in floral tissues.

2.
J Am Chem Soc ; 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32212651

RESUMO

Olivine Fe2GeS4 has been identified as a promising photovoltaic absorber material introduced as an alternate candidate to iron pyrite, FeS2. The compounds share similar benefits in terms of elemental abundance and relative non-toxicity, but Fe2GeS4 was predicted to have higher stability with respect to decomposition to alternate phases and, therefore, more optimal device performance. Our initial report of the nanoparticle (NP) synthesis for Fe2GeS4 was not well understood and required an inefficient 24 h growth to dissolve an impurity phase. Here, we report an improved, amide-assisted Fe2GeS4 NP synthesis that directly forms the phase-pure product in minutes. This significant advance in the quality of the reaction was achieved by the replacement of the poorly-understood hexamethyldisilazane (HMDS) additive and TMS2S by its conjugate base, lithium bis(trimethylsilyl)amide (LiN(SiMe3)2) and elemental S, respectively. We hypothesized that fragments of both TMS2S and HMDS had carried out the roles that Brønsted bases play in amide-assisted NP syntheses and were necessary for Ge incorporation. Convolution of this role with the supply of S in TMS2S caused the iron sulfide impurities. Separating these effects in the use of LiN(SiMe3)2 and elemental S resulted in synthetic control over the ternary phase. Herein we explore the Fe-Ge-S reaction landscape and the role of the base. Its concentration was found to increase the reactivities of the Fe, Ge, and S precursors, and we discuss possible metal-amide intermediates. This affords tunability in two areas: favorability of NP nucleation versus growth and phase formation. The phase-purity of Fe2GeS4 depends on the molar ratios of the cations, base, and amine as well as the Fe:Ge:S molar ratios. The resultant Fe2GeS4 NPs exhibit an interesting star anise-like morphology with stacks of nanoplates that intersect along a 6-fold rotation axis. The optical properties of the Fe2GeS4 NPs are con-sistent with previously published measurements showing a measured band gap of 1.48 eV.

3.
Respir Care ; 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32184375

RESUMO

BACKGROUND: Extended periods of hypocarbia in preterm infants may be associated with intraventricular hemorrhage, periventricular leukomalacia, and bronchopulmonary dysplasia. To evaluate the current anesthetic practice in preterm neonates, we retrospectively reviewed the intraoperative course with regard to P aCO2 and ventilation during non-cardiac surgical procedures in infants <60 weeks postmenstrual age. METHODS: This was a single-center, retrospective study during non-cardiac surgical procedures in neonates. Hyperventilation was defined as a P aCO2 ≤ 35 mm Hg, significant hyperventilation as a P aCO2 ≤ 30 mm Hg, and extreme hyperventilation as a P aCO2 ≤ 25 mm Hg. RESULTS: The study cohort included 112 neonates, with a median postnatal age of 40 weeks, median gestational age of 38 weeks, and median weight of 5 kg. Thirty-seven subjects (33%) had at least one arterial blood gas value that demonstrated hyperventilation. Thirteen (12%) were noted to have significant hyperventilation (P aCO2 ≤ 30 mm Hg) and 2 had extreme hyperventilation (P aCO2 ≤ 25 mm Hg). CONCLUSIONS: The incidence of at least one arterial blood gas that demonstrated inadvertent hyperventilation in neonates was high during intraoperative care. These data may provide the baseline for future studies that address more rigorous monitoring and control of P aCO2 during intraoperative care. Although the duration of the anesthetic care and surgical procedure is brief compared with the neonatal ICU length of stay because there is no demonstrated benefit of hypocapnia and, in fact, well-documented harm associated with hyperventilation in neonates, care should be directed at limiting inadvertent hyperventilation.

5.
Nat Commun ; 11(1): 1481, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32198425

RESUMO

Despite evident regulatory roles of heparan sulfate (HS) saccharides in numerous biological processes, definitive information on the bioactive sequences of these polymers is lacking, with only a handful of natural structures sequenced to date. Here, we develop a "Shotgun" Ion Mobility Mass Spectrometry Sequencing (SIMMS2) method in which intact HS saccharides are dissociated in an ion mobility mass spectrometer and collision cross section values of fragments measured. Matching of data for intact and fragment ions against known values for 36 fully defined HS saccharide structures (from di- to decasaccharides) permits unambiguous sequence determination of validated standards and unknown natural saccharides, notably including variants with 3O-sulfate groups. SIMMS2 analysis of two fibroblast growth factor-inhibiting hexasaccharides identified from a HS oligosaccharide library screen demonstrates that the approach allows elucidation of structure-activity relationships. SIMMS2 thus overcomes the bottleneck for decoding the informational content of functional HS motifs which is crucial for their future biomedical exploitation.

6.
Sci Transl Med ; 12(529)2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024799

RESUMO

Apolipoprotein E (APOE) ε4 genotype is associated with increased risk of dementia in Parkinson's disease (PD), but the mechanism is not clear, because patients often have a mixture of α-synuclein (αSyn), amyloid-ß (Aß), and tau pathologies. APOE ε4 exacerbates brain Aß pathology, as well as tau pathology, but it is not clear whether APOE genotype independently regulates αSyn pathology. In this study, we generated A53T αSyn transgenic mice (A53T) on Apoe knockout (A53T/EKO) or human APOE knockin backgrounds (A53T/E2, E3, and E4). At 12 months of age, A53T/E4 mice accumulated higher amounts of brainstem detergent-insoluble phosphorylated αSyn compared to A53T/EKO and A53T/E3; detergent-insoluble αSyn in A53T/E2 mice was undetectable. By immunohistochemistry, A53T/E4 mice displayed a higher burden of phosphorylated αSyn and reactive gliosis compared to A53T/E2 mice. A53T/E2 mice exhibited increased survival and improved motor performance compared to other APOE genotypes. In a complementary model of αSyn spreading, striatal injection of αSyn preformed fibrils induced greater accumulation of αSyn pathology in the substantia nigra of A53T/E4 mice compared to A53T/E2 and A53T/EKO mice. In two separate cohorts of human patients with PD, APOE ε4/ε4 individuals showed the fastest rate of cognitive decline over time. Our results demonstrate that APOE genotype directly regulates αSyn pathology independent of its established effects on Aß and tau, corroborate the finding that APOE ε4 exacerbates pathology, and suggest that APOE ε2 may protect against αSyn aggregation and neurodegeneration in synucleinopathies.

7.
J Anesth ; 34(2): 238-242, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31980926

RESUMO

INTRODUCTION: Sugammadex is a novel agent to reverse steroidal neuromuscular blocking agents (NMBA) with potential clinical advantages over acetylcholinesterase inhibitors such as neostigmine. However, rare instances of bradycardia were reported during its initial clinical trials. To better define this issue, its incidence and mitigating factors, we prospectively evaluated heart rate changes after sugammadex administration in pediatric-aged patients. METHODS: Patients less than 18 years of age who were to receive sugammadex were included. After sugammadex administration, heart rate (HR) was recorded every minute for 15 min and then every 5 min for the next 15 min or until the patient was transferred from the operating room. Bradycardia was defined as HR below the 5th percentile for age. RESULTS: The study cohort included 221 children. Bradycardia was noted in 18 cases (8%; 95% confidence interval 5%, 13%), occurring at a median of 2 min (IQR: 1, 6) after sugammadex administration. Among patients developing bradycardia, 7 of 18 (38%) had comorbid cardiac conditions (congenital heart disease). No patient required treatment for bradycardia and no clinically significant blood pressure (BP) changes were noted. On bivariate analysis, initial sugammadex dose was not associated with bradycardia onset. In multivariable analysis, cardiac comorbid conditions and male gender were associated with an increased incidence of bradycardia. CONCLUSIONS: The incidence of bradycardia following the administration of sugammadex is low, is not associated with BP changes or other clinically significant effects, and did not require treatment. A higher incidence of bradycardia was noted in patients with cardiac comorbid conditions.

8.
J Control Release ; 319: 222-233, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31891732

RESUMO

The purpose of this exploratory study was to investigate the combination of a radiopharmaceutical, nanoparticles and ultrasound (US) enhanced delivery to develop a clinically viable therapeutic strategy for tumours overexpressing the epidermal growth factor receptor (EGFR). Molecularly targeted radionuclides have great potential for cancer therapy but are sometimes associated with insufficient delivery resulting in sub-cytotoxic amounts of radioactivity being delivered to the tumour. Liposome formulations are currently used in the clinic to reduce the side effects and improve the pharmacokinetic profile of chemotherapeutic drugs. However, in contrast to non-radioactive agents, loading and release of radiotherapeutics from liposomes can be challenging in the clinical setting. US-activated cavitation agents such as microbubbles (MBs) have been used to release therapeutics from liposomes to enhance the distribution/delivery in a target area. In an effort to harness the benefits of these techniques, the development of a liposome loaded radiopharmaceutical construct for enhanced delivery via acoustic cavitation was studied. The liposomal formulation was loaded with peptide, human epidermal growth factor (HEGF), coupled to a chelator for subsequent radiolabelling with 111Indium ([111In]In3+), in a manner designed to be compatible with preparation in a radiopharmacy. Liposomes were efficiently radiolabelled (57%) within 1 h, with release of ~12% of the radiopeptide following a 20 s exposure to US-mediated cavitation in vitro. In clonogenic studies this level of release resulted in cytotoxicity specifically in cells over-expressing the epidermal growth factor receptor (EGFR), with over 99% reduction in colony survival compared to controls. The formulation extended the circulation time and changed the biodistribution compared to the non-liposomal radiopeptide in vivo, although interestingly the biodistribution did not resemble that of liposome constructs currently used in the clinic. Cavitation of MBs co-injected with liposomes into tumours expressing high levels of EGFR resulted in a 2-fold enhancement in tumour uptake within 20 min. However, owing to the poor vascularisation of the tumour model used the same level of uptake was achieved without US after 24 h. By combining acoustic-cavitation-sensitive liposomes with radiopharmaceuticals this research represents a new concept in achieving targeted delivery of radiopharmaceuticals.

9.
Community Ment Health J ; 56(1): 32-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31659550

RESUMO

This study employed a citizenship measure to explore mental health providers' views of citizenship to support the societal participation of people with mental illnesses, with citizenship defined as a person's (or people's) strong connection to the 5Rs of rights, responsibilities, roles, resources and relationships and a sense of belonging that is validated by others. Providers identified key structural barriers to full citizenship for clients. Their comments reflect openness to citizenship as a framework for understanding their clients and the need for greater access to normative community life, but also skepticism regarding providers' and public mental health centers' abilities to incorporate citizenship approaches in current care models. Findings suggest there are challenges to implementing "citizenship-oriented care" in public mental health settings, but efforts to address these challenges can support the goal of "a life in the community."

10.
J Anesth ; 34(1): 149-152, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31807872

RESUMO

While oxygen administration has been in clinical practice, the focus has generally been on avoidance of hypoxemia. More recently, renewed emphasis has been placed on the potential deleterious effects of hyperoxia. The aim of this study is to investigate the incidence of intraoperative inadvertent hyperoxia among neonate, which was defined at three different thresholds: normoxia (PaO2 60-100 mmHg), hyperoxia (PaO2 101-199 mmHg), and severe hyperoxia (PaO2 ≥ 200 mmHg). This study included 65 patients with 174 eligible arterial blood gas (ABG) samples, who were less than 60 weeks post-menstrual age and required a non-cardiac surgical procedure. Among the 65 patients, 62 (96%) patients experienced either hyperoxia or severe hyperoxia during general anesthesia on at least one ABG. Among the 174 ABG readings, only 28 (16%) had PaO2 levels within our defined normoxia range. The incidence of hyperoxia in neonate under general anesthesia is high. Although it is unknown if brief exposure during anesthesia is associated with similar outcomes, educational initiatives seem warranted to increase awareness of these clinical concerns, as there seems to be limited clinical benefit from such care.

11.
Dig Dis Sci ; 65(1): 104-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332626

RESUMO

BACKGROUND: Evidence of geographical differences in liver transplantation (LT) outcomes has been proposed as a reason to include community characteristics in risk adjustment of transplant quality metrics. However, consistency and utility of rankings in LT outcomes for counties have not been demonstrated. AIMS: We sought to evaluate the utility of county rankings (county socioeconomic status (SES) or county health scores (CHS)) on outcomes after LT. METHODS: Using the United Network for Organ Sharing Registry, adults ≥ 18 years of age undergoing LT between 2002 and 2014 were identified. County-specific 1-year survival was calculated using the Kaplan-Meier method for counties with ≥ 5 LT performed during this period. Agreement between high-risk designation by 1-year mortality rate and county ranking was calculated using the Spearman correlation coefficient. RESULTS: The analysis included 47,769 LT recipients in 1092 counties. County 1-year mortality rates were not correlated with county CHS (Spearman ρ = 0.01, p = 0.694) or county SES (Spearman ρ = - 0.01, p = 0.734). After controlling for individual-level covariates, a statistically significant variability in mortality hazards across counties (p < 0.001) persisted. Although both CHS and SES measures improved the model fit (p = 0.004 and p = 0.048, respectively), an unexplained residual variation in mortality hazard across counties continued. CONCLUSIONS: There is poor agreement between county rankings on various socioeconomic indicators and LT outcomes. Although there is variability in outcomes across counties, this appears not to be due to county-level socioeconomic indices.

12.
J Urban Health ; 97(1): 112-122, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30547363

RESUMO

The mass incarceration of African Americans is both a driver of racial health inequalities in the USA. Systemic social biases which associate African American men with criminality, violence, and as a particular threat to white women may partially explain their over-representation in the criminal justice system. We combined data from the Washington, DC Metro Police Department (MPD) and the American Community Survey to test whether neighborhood-level gender, race, and economic makeup were associated with elevated drug-related arrest disproportions for African American men. We found that African American men were significantly overrepresented in all drug-related arrests across the District, and that this arrest disproportion was significantly higher in neighborhoods that had a higher percentage of white female residents. The association between race and gender was somewhat attenuated, but not completely eliminated, when we introduced socio-economic variables to our model. Addressing the social determinants of criminal justice disparities must account for the intersection of race, gender, and economics, rather than considering race in isolation.

14.
J Interpers Violence ; : 886260519888208, 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31738110

RESUMO

Sexual assault on university campuses has attracted growing attention, but there is little data available on the scope of the problem in Southern Africa. We sought to measure the prevalence of campus sexual assault among female university students at the University of Eswatini and describe the experience of survivors using a mixed-methods study design. Women were randomly sampled from a list of all full-time female university students provided by the office of the registrar, and participants completed a brief behavioral survey in a private study office using a tablet with computer-assisted self-interview software. Women who indicated experiences of sexual violence during the survey were invited to self-identify themselves to study staff to participate in a follow-up qualitative interview. We measured sexual assault using the Sexual Experiences Survey-Short Form Version (SES-SFV). We found that women in University were over 6 times more likely to report forced or coerced sex in the previous 12 months than has been previously reported in the general population. Sixty percent of participants reported experiencing an attempted or completed sexual assault in their lifetime, and a total of 38% reported an assault in the past 12 months. The vast majority (93%) of assailants were known to their victim, and the majority (56%) of perpetrators were romantic partners. The majority of participants had never disclosed their assault, and victim blaming and stigma emerged as highly salient themes during in-depth qualitative interviews. Food insecurity, losing a parent before age 21, and hazardous drinking were all significantly associated with experiencing sexual assault in the previous 12 months, as was experiencing a previous assault before the age of 18. To our knowledge, this is the first generalizable study of campus sexual assault prevalence conducted in the Southern African region.

15.
Med Devices (Auckl) ; 12: 297-303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31686922

RESUMO

Purpose: To compare invasive blood pressure (IBP) readings obtained from an arterial cannula with non-invasive blood pressure (NIBP) measurements from oscillometric cuffs on the upper and lower extremities of infants and children under general anesthesia. Patients and methods: Patients under 10 years of age were enrolled in our study if they were to receive general anesthesia with planned placement of a radial arterial cannula. At 5 mins intervals, IBP was measured using a fluid-coupled pressure transducer and NIBP was measured with two oscillometers with appropriately sized cuffs placed on the upper arm and lower leg, for 10 readings per patient. Results: The study enrolled 18 boys and 12 girls, ranging in age from 0 to 8 years. Across 300 data points, the absolute difference between the arm and invasive mean arterial pressure (MAP) measurements was 7±7 mmHg (range: 0-52 mmHg). The absolute difference between the leg and invasive MAP measurements was 8±8 mmHg (range: 0-52 mmHg). Although both non-invasive measurement sites demonstrated frequent deviation from invasive measurement, large deviations were more common when BP was measured at the leg (81 of 298 observations (27%) deviating by >10 mmHg) compared to the arm (60 of 300 observations (20%) deviating by >10 mmHg). Conclusion: The frequency of clinically significant NIBP deviation in children under general anesthesia supports the importance of IBP monitoring when hemodynamic fluctuations are likely and would be particularly detrimental. NIBP measured at the lower leg is more likely to result in clinically significant deviation from invasively measured MAP than NIBP values obtained from an upper arm.

16.
Funct Plant Biol ; 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31615620

RESUMO

Plant nutrition can affect the allocation of resources to plant chemical defences, yet little is known about how phosphorus (P) supply, and relative nitrogen (N) and P supply, affect chemical defences, especially in species with intrinsically conservative nutrient use adapted to P-impoverished soils. Waratah (Telopea speciosissima (Sm.) R.Br.), like other Proteaceae, is adapted nutrient-poor soils. It was identified as having cyanogenic glycosides (CNglycs) throughout the plant. T. speciosissima seedlings were grown for 15 weeks under two N and P concentrations. CNglycs (N-based defence) and nutrients were quantified in above- and below-ground organs; foliar carbon (C)-based phenolics and tannins were also quantified. CNglyc concentrations in roots were on average 51-fold higher than in above-ground tissues and were affected by both N and P supply, whereas foliar CNglyc concentrations only responded to N supply. Leaves had high concentrations of C-based defences, which increased under low N, and were not correlated with N-based defences. Greater root chemical defence against herbivores and pathogens may be important in a non-mycorrhizal species that relies on basal resprouting following disturbance. The differing responses of secondary chemistry in above- and below-ground organs to P and N demonstrate the importance of broadening the predominantly foliar focus of plant defence studies.

17.
Int J Pediatr Otorhinolaryngol ; 127: 109661, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476606

RESUMO

INTRODUCTION: Obstructive Sleep Apnea (OSA) and Sleep Disordered Breathing (SDB) in children tend to be a more complex and multifactorial disease than in adults. Although adult screening tools, such as the STOP-BANG questionnaire, their application limited in pediatrics. We used our previously described 6-point questionnaire to identify OSA in children and evaluated its use for predicting post-operative respiratory events. METHODS: Children from 3 to 18 years of age presenting for surgery were eligible. Exclusion criteria were emergency surgery or refusal to participate. A 6-question survey regarding symptoms of OSA/SDB was administered preoperatively. Neck circumference was measured. Height and weight were recorded from preoperative data and the body mass index (BMI) percentile obtained. RESULTS: 749 patients were enrolled in the study. 707 patients were in the final analysis (359 boys and 348 girls, mean age 12 ±â€¯4 years). The median 6-item questionnaire score was 1 (interquartile range: 0, 2) and 186 (26%) scored ≥ 2 of 6 points. Children with predicted OSA (yes on ≥ 2 questions) were more likely than without predicted OSA to require supplemental oxygen in the PACU (24% vs. 17%; 95% confidence interval [CI] of difference: -0.3%, 13%; p = 0.049). Amongst 681 patients with available data on Post Anesthesia Care Unit (PACU) length of stay (LOS), prolonged LOS (>1 h) was not more likely among children with predicted OSA (42%) compared to those without predicted OSA (39%; 95% CI of difference: -5%, 11%; p = 0.479). Outcomes assessed after PACU discharge noted no differences. Specifically, overnight hospital stay was required in 33% of patients with predicted OSA as compared to 29% of those without (95% CI of difference: -4%, 11%; p = 0.399). On POD 0, supplemental oxygen was used on the inpatient ward for 6% of patients with predicted OSA compared to 4% of patients without predicted OSA (95% CI of difference: -2%, 6%; p = 0.272). CONCLUSION: The incidence of OSA/SDB is under-appreciated in children presenting for non-otolaryngological surgical procedures. Although patients judged to have OSA on the 6-item question may need for supplemental oxygen longer in the PACU, no other outcomes differences were noted.


Assuntos
Tempo de Internação , Oxigênio/administração & dosagem , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários , Adolescente , Índice de Massa Corporal , Criança , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Sala de Recuperação
18.
Psychol Serv ; 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31424240

RESUMO

Views on what is important in training for psychologists are evolving, reflecting a broadening understanding of the role psychologists can and should play in societal change. Since the development of the scientist-practitioner model after World War II, arguments around training have focused on the appropriate balance between training in the practice of psychology versus training in research related to psychology. Recent calls reflect more radical change to include an advocacy emphasis within the formal coursework of psychology doctoral programs, well articulated by Mallinckrodt, Miles, and Levy (2014) as the tripartite model of Scientist-Practitioner-Advocate. In this paper, we present the argument for expanding a model that incorporates advocacy training into clinical psychology internships and postdoctoral programs and describe why we believe voices for advocacy have been largely silent in public-sector clinical psychology training and practices. We outline how this may be accomplished in public sector training settings, and we articulate a call to action for public servants to speak out so their voice can ignite a passion for advocacy within public sector psychology service and training. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

19.
J Grad Med Educ ; 11(4 Suppl): 213-217, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428292

RESUMO

Background: There is worldwide interest in assessing the impact of accreditation systems to quantify their benefits to medical education and, through this, health care at the local and global levels. Objective: We analyzed ACGME-I Resident Survey data from Singapore for 2011-2018 to assess the impact of accreditation on residents' evaluations of their programs. Methods: We focused on 7 questions from the annual Resident Survey, which would be affected by accreditation compliance, along with a single global rating of respondents' overall perception of their program. We assessed for differences among specialty groupings (medical, surgical, and hospital-based) and Singapore's 3 health care systems. Repeated measures analysis of variance procedures was used to assess trends across time for the combined 8 items and each individual item. Results: Analysis of the combined items showed significant improvement over the 7 years Singaporean programs had accreditation. There were no effects for specialty type or sponsoring institution. Analyses of individual questions showed 6 of 8 were significant for improvement. For the individual question related to duty hour compliance, there was a significant interaction between time and specialty, suggesting medical specialties showed greater improvement across time compared to surgical and hospital-based specialties. Conclusions: Implementation of accreditation in Singapore provided educational and clinical learning environment infrastructure not present prior to 2010, with the benefits of this reflected in residents' perceptions of their learning environment. Future assessments of the effects of accreditation might add stakeholder interviews to more fully describe its value and impact.


Assuntos
Acreditação , Internato e Residência , Aprendizagem , Tolerância ao Trabalho Programado , Educação de Pós-Graduação em Medicina , Humanos , Singapura , Inquéritos e Questionários , Carga de Trabalho/normas
20.
J Am Coll Clin Pharm ; 2(4): 383-401, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31460498

RESUMO

Introduction: Referrals to community resources represent one element of the Chronic Care Model, however, little is known about the perceived role of community pharmacy staff in referring patients to community resources. Objectives: The objective of this study was to describe community pharmacists', community pharmacy technicians', and patients' perceptions of pharmacist referrals to community resources. Methods: Semi-structured interviews were conducted with community pharmacists, pharmacy technicians, and patients from community pharmacies that are members of the Medication Safety Research Network of Indiana (Rx-SafeNet). Qualitative analysis was conducted to identify emergent themes. Results: A total of 37 participants, including six community pharmacists, one pharmacy student completing an advanced pharmacy practice experience, 15 community pharmacy technicians, and 15 patients across four independently-owned community pharmacies were interviewed. Themes included: 1) Need to build on a foundation of strong patient-community pharmacist relationships to clearly define the pharmacist's role in referrals, 2) Need to improve familiarity with community resources, 3) Need to clearly delineate and support the role for pharmacy technicians in making referrals, and 4) Need to follow-up on referrals. Conclusion: To enhance community pharmacy staff provision of referrals to community resources, interventions are needed to improve patient and pharmacist familiarity with available resources, patients' perception of the pharmacist's role outside of prescription fulfillment, and follow-up on referrals. Moreover, pharmacy technician education and training could be expanded to optimize their role in supporting community pharmacists in making referrals.

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